A 48-year-old woman complained about the appropriateness of the
chiropractic care provided to her by a registered chiropractor. The
woman had an eight-month history of lower back and leg pain and
sought treatment from the chiropractor on four occasions within a
month.

At the first consultation the chiropractor diagnosed the woman
with right hip bursitis, left sacroiliac joint bursitis, cervical
bursitis, and possible pseudo-sciatic symptoms. He also manipulated
her lower back. At the second consultation he performed a technique
called "urtication", which involved applying a piece of stinging
nettle to various parts of the woman's body including her abdomen.
He did not ask permission to undo the top button of her trousers in
order to apply the stinging nettle to her abdomen.

At another appointment, after the patient showed some discomfort
during a manipulation of her neck, the chiropractor performed a
Periosteal Sensitivity test, which involved the application of
pressure to her clavicle and shin bones. He also performed a Poison
Point test, which involved touching the woman's breasts through her
clothing. The woman stated that she was "beside herself" when she
left the consultation. She attended an appointment with a nurse
later that day and advised the nurse that the chiropractor had
pinched her nipples. The chiropractor did not adequately explain
the risks and benefits of the procedure and how it would be
performed. During another appointment the chiropractor performed
further manipulations of her neck.

An orthopaedic surgeon subsequently diagnosed the woman with a
disc prolapse.

It was held that the chiropractor's initial assessment was
inappropriate and inadequate. He did not have sufficient clinical
rationale for his diagnoses of the woman's condition, nor was there
evidence that he gave adequate consideration to whether she had a
potential disc prolapse despite her clinical presentation
indicating that he ought to have done so. Accordingly, the
chiropractor breached Right 4(1).

The treatments that the chiropractor provided were not
clinically appropriate in light of the woman's reported symptoms of
lower back and leg pain. His clinical rationale for manipulating
her cervical spine was flawed, and his decisions to perform
urtication, a periosteal sensitivity test, and a poison point test
were not clinically indicated. He therefore breached Right 4(1) by
failing to provide services with reasonable care and skill.

The chiropractor had a duty to inform the woman about her
condition, to explain that the techniques he was proposing to use
were unorthodox, and to provide information about the validity and
efficacy of those techniques, as well as the location of the
proposed treatment. He breached Right 6(1) for failing to provide
information that a reasonable consumer, in the woman's
circumstances, would expect to receive. Because she did not receive
sufficient information, she was not in a position to provide
informed consent to the unorthodox chiropractic techniques.
Accordingly, the chiropractor also breached Right 7(1).

By not keeping clear, legible and full records of the services
he provided, the chiropractor failed to comply with his
professional obligations and, accordingly, breached Right 4(2). The
chiropractor will be referred to the Chiropractic Board of New
Zealand.